Provider Demographics
NPI:1417391053
Name:LIVE WELLNESS CENTER, LTD.
Entity Type:Organization
Organization Name:LIVE WELLNESS CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-437-9910
Mailing Address - Street 1:1335 DUBLIN RD STE 212C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1000
Mailing Address - Country:US
Mailing Address - Phone:614-437-9910
Mailing Address - Fax:614-453-5975
Practice Address - Street 1:1335 DUBLIN RD STE 212C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7037
Practice Address - Country:US
Practice Address - Phone:614-437-9910
Practice Address - Fax:614-453-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1300177101YM0800X
OHE1000414101YP2500X
OHE0500525101YP2500X
OHC0800038101YP2500X
OHC0900170101YP2500X
OHE0004105101YP2500X
OHI. 12004831041C0700X
OHI. 0800196 S1041C0700X
OHI07000751041C0700X
OHS14300051041C0700X
1041C0700X
OHM1300008106H00000X
OHM1300023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty